Summary:

Professor Sandra Bertman founded the Medical Humanities Program at the University of Massachusetts Medical Center and holds certificates in grief counseling and death education. This handbook outlines how she uses the visual and literary arts to "improve our professional abilities to deal with death and dying." Her premise is that the arts provide a valuable vehicle for exploring and making bearable the prospect and fact of death.

Bertman illustrates her presentation technique (Chapter 2) of juxtaposing dual images around six central themes, here abbreviated: the chosen death; death and afterlife; existential aloneness; loss of control, unmentionable feelings, grief; the land of the sick vs. the land of the well; the moment of death. The book offers dozens of paintings, sketches, and photographs (reproduced in black and white), as well as many literary excerpts. Classic works are represented (David's painting, The Death of Socrates; Michelangelo's sculpture, "Pieta"; Tolstoy's novel, The Death of Ivan Ilyich) but there are many unusual representations as well--greeting card messages, epitaphs, cartoons.

In addition, some groups with whom she works (for example, medical students studying Gross Anatomy) have submitted their own drawings and commentary. These are shown in Chapter 3, along with written responses to a follow-up Death Attitude Questionnaire. Responses are from junior and senior high school students; college students; medical students; graduate nurses; hospice volunteers.

Chapter 4 gives suggestions for how to use images and texts and for how to approach discussions of loss and grief. The course syllabus for "Dissection, Dying, and Death," taught with Gross Anatomy, is appended, and there is an extensive bibliography.

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Film clips of Cary Grant as the consummate anatomy professor in 0100 (see this database) are interspersed with comments from contemporary gross anatomy students, two medical school faculty intimately connected with dissection and the body donation tradition, and a live body donor. In what ways "yes" and "no" could both be proper responses to the statement, "A cadaver in the classroom is not a dead human being" is the key premise, beautifully presented in the cut-aways, organization, and editing of this piece.

The structure of the film is an as-if dialogue between young dissectors and soon-to-be cadaver (the body donor). Interviews heighten and explore the relationship between the living and the dead--and not just medical students and body donors. The medical students do not speak directly with the future donor, though we see him shaking hands with them, visiting (and speculating on) the spot where his remains will eventually be deposited. The video concludes with a moving annual ritual, the disposition of body donors' cremated remains at sea.

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Nina Spiers comes home to find that her husband, Lewis, has committed suicide. Lewis, a former high-school biology teacher, had ALS, and they had discussed this possibility, but Lewis has not included Nina in his final decision and its enactment. She searches in vain for a last message from Lewis, but can find nothing. We learn that Lewis left his teaching job over the community's pressure on him to incorporate the possibility of divine creation in his teaching of evolution; profoundly rationalist and scornful of religion, he refuses and resigns.

Lewis's body is taken to the local funeral home where, inadvertently, it is embalmed, which he would not have wanted. Ed Shore, the undertaker, arranges to have the body cremated immediately and brings Nina a note found in Lewis's pajamas. Instead of a message for her, it is a piece of badly-written satirical verse about the school and the argument between creationism and science. There is nothing for Nina.

Later Ed brings Nina the ashes. Ed and Nina have a history: once, on an evening when Lewis and Kitty, Ed's saint-loving Anglican wife, were engaged in a fierce argument, Ed had kissed Nina. Now, they talk of the preservation of the body and the existence of the soul. Nina then takes Lewis's ashes and scatters them at a crossroads outside of town. At first she feels shock at what she is doing, and then pain, but we infer too that as she sheds the comfortable self-effacement of her role as Lewis's wife, Nina is perhaps coming back to life herself.

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Twelve-year-old Lily Star has lost her father and moved from a cabin in the woods on the river where she grew up fishing with her father, and where she knew the natural creatures as neighbors, to an apartment in the nearby city where she and her mother continue to run the family hardware store. While she still loves the river, she finds it hard to "forgive" it because it drowned her father in a boating accident. She also resents the fact that an important stretch of land along the river is being fenced off by the man to whom the cabin was sold--T.R.--a recluse in a wheelchair. Through a series of unpleasant encounters, Lily gets to know him and learns that he had been a pilot and was disabled in an accident.

The bond the two discover over time has to do with somewhat parallel paths of healing: he needs to "forgive" the sky as she does the river. She persuades him eventually to go boating with her. Even a fall in the water doesn't discourage him from taking on new life and hope by accepting Lily's invitations to get to know the river, the land, and the neighbors. Lily's hopes that he might remain and marry her mother are disappointed when he decides to return to work with planes, though he can no longer pilot them, but the friendship that strengthened them both in their struggles with grief and loss makes it a parting full of promise.

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While driving away from a dangerous city in an area of north Afghanistan ravaged by war, three men must journey by foot when their car is damaged in an accident. Donk is an American combat photographer. Hassan is a young Afghan translator. Graves is a British journalist suffering from a severe case of malaria and in desperate need of medication.

They arrive at a remote village ruled by a warlord, General Ismail Mohammed. Medication is unavailable there and transportation to a larger city is not possible for at least another day. The local doctor recommends an herbal remedy for the treatment of malaria, and General Mohammed attests to its effectiveness. The medicinal grass grows only in a nearby mountain valley. Two soldiers escort Donk and Hassan to the vale. They encounter a convoy of transport vehicles that have been incinerated by a bomb blast.

When the grass is finally in sight, Donk and Hassan race towards it even as the two soldiers shout at them. Too late! Donk steps on a bomblet and the device detonates. Badly injured (and maybe even mortally wounded), Donk and Hassan lie on their backs and gaze at the sky. They are surrounded by the thick grass they hoped might save the life of their companion, Graves.

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In his mid-twenties and having been estranged from his family since his mid-teens, Andrew Largeman (Zach Braff) returns home to New Jersey for a few days to attend his mother's funeral. The world he meets there (in "The Garden State," ironically) is persistently unnatural and weird. His old school friends are leading grotesque and diminished lives, and Andrew dislikes and dreads his father, a psychiatrist played by Ian Holm, because of the prehistory we discover in mid-film. (Andrew's mother had suffered with depression, and young Andrew hated her for it. One day, aged 9, he gave her a shove, and freak circumstances led to a hard fall and her becoming paraplegic. Fifteen years later she has died in her bathtub, perhaps a suicide--although that isn't mentioned in the film.)

Andrew keeps his psychic distance from all this, with one fortunate exception: By chance he meets Samantha or "Sam" (Natalie Portman), a sweet loopy girl his age who lives in a child-like room in her mother's house and has a tendency to lie a lot and then confess. She and Andrew take a liking to each other, and a relationship develops that eventually helps Andrew come to terms with his mother's death, with his role in the tragic prehistory, and, thus, with his father and his own life, now able to begin, finally, as a young adult.

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As Bertman says in her introduction, this book "is meant to refuel therapists, counselors, social workers, physicians, nurses, clergy and all others who are committed to providing support to those in grief." While the caregivers' focus is on those in grief, they also have to give some attention to their own bodies, minds and spirits. This collection of essays, poems and stories, illustrated with drawings and photographs, examines grief from several perspectives.

The opening section looks at professional roles in experiencing and understanding suffering and empathy. Section two provides several descriptions of how caregivers use the arts for themselves and for those they companion. Section three is devoted to lessons from old and new cultures. The final section explores basic needs of grieving people.

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The surgeon-narrator and his team of assistants (the anesthesiologist, scrub nurse, circulating nurse, surgical resident, and medical student) perform a difficult operation during the night. The patient has an infiltrating cancer of the stomach (linitis plastica) that has eroded his aorta. Because of uncontrollable bleeding, the operation (an exploratory laparotomy with attempted repair of a malignant aorto-gastric fistula) is as doomed as the patient himself.

The surgeon soon comprehends the hopelessness of the procedure as well as the patient's terminal condition. He turns off the oxygen from the gas tank and stops the patient's blood transfusion. Minutes later, the man dies. Blood is all over everything. The doctor must now deliver the bad news to the man's family. He has the medical student tag along.

Members of the patient's family are upset and some are even out of control so he dispenses tranquilizers to them. The surgeon returns to the operating room (OR) and even now finds blood everywhere. The OR team is still working. The doctor showers and then goes back to the OR once more. The room is now dark and empty but clean. The surgeon imagines the dead man's body with a row of abdominal stitches that he likens to hieroglyphics. The unsuccessful operation and the surgeon's actions are thus both concealed and unforgettable.

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The author of this bold collection is a registered nurse who relates, through her poems, patient and caregiver experiences culled from her own years of working in Intensive Care-Coronary Care. There are 24 poems here, most running two to three pages and most written in short lines, a point of craft that adds to their power. There is not one moment of easy sentimentality in these poems. Instead, the author plunges into the grittier side of nursing and illness--and yet, in aggregate, these poems celebrate the embodied and holy work of healing.

In the opening poem, "The-Trickle-Down-Theory-Of-Health," Adam, in the Garden of Eden, is surprised by "The knife" that "separates his ribs." By poem's end, we see health slip "like a ring / from earth's finger" (2), and with this simile we are introduced to the book's underlying metaphor and also to the poet's technique: dense and sometimes near-extreme imagery that ranges, in this poem alone, from encyclopedias to acid rain to barefoot children to librarians to a patient in the dark, "her arteries and shelves / of bone in a ruby gloom" (2). This accumulation of unrelenting, unusual images recreates the world of a patient's pain and suffering and the fierce determination and occasional despair of a caregiver.

"Coma" is written from a comatose woman's point of view, and yet we also see her from the nurse's vantage. In a lovely and surprising twist, the coma becomes, for the patient, a sort of liberation as "Slowly she sloughs, / cell by cell, / the old thorn" (15). This patient is not Sleeping Beauty, who in some fairy tale might be wakened by a kiss. "On the Fireline" becomes a wonderful metaphor for the daily confrontation of illness, for the way the nurse, returning daily to tend her patients, also "coalesces into fire" (16).

The 5-page poem "Intensive Care" perfectly renders the physical sense of being alternately caregiver, patient, and family member within the rarified atmosphere of the ICU (24-28). A patient's blood "pulls against/ the moon, his breath / this tide going out" (26) and, as she comforts a waiting family member, a nurse's eyes "beyond clarity, / unfold a silken language / all their own" (28).

Other not-to-be-missed poems are "The Holy O" (36), "Prayer to a Purple God" (38), "Pieta" (44), "A Riot of Flowers" (52), "What the Body Remembers" (57), and one of my very favorites, "Anesthesia" (59). In "Anesthesia" the caregiver lets an anesthetized patient float like "an embryo / tethered on the end of IV tubing, / floated like an astronaut / in cold stratosphere, / a naked thing / alone / in the universe" (60). But since these poems are finally loving, involved, experienced and hopeful, the patient is told to hush; he is watched over; he is protected. When danger is past, he is reclaimed: "She will hold you / within white-curved wings. / She will reel you back in / when you are healed" (60).

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The narrator of this straightforward little story about the loss of a friend is a young boy who is remembering what he and Nathan did together. He goes through a series of routine events he and Nathan shared, including teasing Nathan's sister about her pitching arm, nibbling strawberries on the way to school, and practicing their speeches together. The children in class make a "memory box" commemorating Nathan, but his best friend, the narrator, can't participate. His feelings are too complicated. With a little help from an old neighbor, a little time alone in the treehouse and other places he and Nathan frequented, he discovers new possibilities of friendship in Nathan's sister and ways of remembering Nathan that are all his own.

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